Effectiveness of Secundum Atrial Septal Defect Occlusion with the Septal Occluder through Right-chest Small Incision: Clinical Analysis of 140 Cases / 中国医学科学院学报

Objective To evaluate the feasibility and effectiveness of secundum atrial septal defect(ASD)occlusion with the septal occluder through right-chest small incision. Methods The clinical data of 140 secundum ASD patients (47 males and 93 females) aged 3-63 years who were treated in our center from August 2004 to July 2014 were retrospectively analyzed. The diameter of ASD was 6 to 36 mm. Under general anesthesia, all patients underwent intraoperative transtsophageal echocardiography (TEE), during which no associated cardiac deformity was found. All patients received ASD occlusion via a small incision (3-4 cm) at the right anterior chest. The occluders were released with the help of TEE. Results The atrial septal defect closure was successfully completed in 134 cases. Six cases received surgical closure of ASD after the failure of occlusion. The reasons of conversion included postoperative dislodgement of occlusion device (n=2, both were central type with large size) and technically unsuitable for occlusion (n=4, in whom residual shunt was found in 2 case, sieve pore type in 1 case, and intraoperative dislodgement in 1 case). All of these 6 patients were treated surgically under cardiopulmonary bypass. No dislocation of the device or atrial shunt was found within 3 to 48 months after the operation. Conclusion Occlusion via small chest incision of ASD under TEE guidance without cardiopulmonary bypass is a safe, minimally invasive, effective, and convenient treatment and worth clinical application.

Clinical experience of combined surgical thrombectomy and endovascular intervention for acute deep venous thrombosis / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcome of surgical venous thrombectomy and simultaneous stenting in patients with acute, symptomatic iliofemoral deep venous thrombosis (DVT).</p><p><b>METHODS</b>From October 2008 to December 2010, a total of 15 patients with acute symptomatic DVT underwent combined surgical venous thrombectomy and endovascular stenting in ipsilateral iliac vein. There were 6 male and 9 female patients, with a mean age of 57.4 years (ranging from 36 to 71 years). All patients underwent Duplex ultrasonography for diagnosis of DVT. The location of thrombosis was femoro-ilio-caval vein in 2 cases, bilateral iliac vein in 1 case and left iliofemoral vein in 12 cases. All patients had leg swelling and 12 cases had severe leg pain. The mean time of symptomatic DVT occurring at operation was 3.3 d. The factors related to DVT were operation in 6 cases, DVT reoccur in 2 cases. Coexist diseases were digestive tract bleeding in 1 case, gastric ulcer in 1 case, hypertension in 3 cases and 1 case had cerebral infarction. The inferior vena cava filter was inserted before thrombectomy, iliac vein compression and residual stenosis were treated with a self-expandable stent after thrombectomy.</p><p><b>RESULTS</b>Intraoperative venography showed severe venous stenosis in all patients including 80% of iliac vein compression syndrome, 18 self-expandable stents were inserted successfully, the procedural successful rate was 100%, the 30-day mortality rate was 0.One case was suffered from hematoma at incision after operation. 3 patients were lost during follow-up. Median follow-up was 10.3 months (ranging from 2 to 26 months). There was no case of re-thrombosis. Leg pain was disappeared in all cases and only 2 patients showed slight leg swelling after excise.</p><p><b>CONCLUSION</b>Combined surgical thrombectomy and endovascular treatment for patients with acute symptomatic iliofemoral venous thrombosis is an effective and safe technique with low morbidity and good clinical results.</p>